Antibiotic Resistance in Wastewater Treatment Plants and Transmission Risks for Employees and Residents: The Concept of the AWARE Study

Abstract

Antibiotic resistance has become a serious global health threat. Wastewater treatment plants may become unintentional collection points for bacteria resistant to antimicrobials. Little is known about the transmission of antibiotic resistance from wastewater treatment plants to humans, most importantly to wastewater treatment plant workers and residents living in the vicinity. We aim to deliver precise information about the methods used in the AWARE (Antibiotic Resistance in Wastewater: Transmission Risks for Employees and Residents around Wastewater Treatment Plants) study. Within the AWARE study, we gathered data on the prevalence of two antibiotic resistance phenotypes, ESBL-producing E. coli and carbapenemase-producing Enterobacteriaceae, as well as on their corresponding antibiotic resistance genes isolated from air, water, and sewage samples taken from inside and outside of different wastewater treatment plants in Germany, the Netherlands, and Romania. Additionally, we analysed stool samples of wastewater treatment plant workers, nearby residents, and members of a comparison group living ≥1000 m away from the closest WWTP. To our knowledge, this is the first study investigating the potential spread of ESBL-producing E. coli, carbapenemase-producing Enterobacteriaceae, and antibiotic resistance genes from WWTPs to workers, the environment, and nearby residents. Quantifying the contribution of different wastewater treatment processes to the removal efficiency of ESBL-producing E. coli, carbapenemase-producing Enterobacteriaceae, and antibiotic resistance genes will provide us with evidence-based support for possible mitigation strategies.

International travel as a risk factor for carriage of extended-spectrum β-lactamase-producing Escherichia coli in a large sample of European individuals - The AWARE Study

“…The study population comes from participants enrolled in the large trans-European cross-sectional AWARE study (Antibiotic Resistance in Wastewater: Transmission Risks for Employees and Residents around Wastewater Treatment Plants). The full methodology of this project has been previously described (2,52). The subset of the data used in these analyses corresponds to individuals from the general population living more than 1000 meters away from a local WWTP, and thus not exposed to potential AR bacteria coming from such facilities.…”

“…The questionnaire also included questions about potential risk factors for carriage of ESBL-EC in the past year such as job history, hospital and farm visits (no, yes), contact with animals (no, yes), contact with patients or human tissues at work (never, rarely, sometimes, often, always), use of antibiotics and antacids (no, yes, do not know), self-reported health status (poor, fair, good, very good, excellent), self-reported frequency of diarrhea (never, rarely, sometimes, often, always), surgeries (no, yes), and international travel to Europe, Asia, North Africa, Sub-Saharan Africa, North America, Central America or Mexico, South America, and Australia or Oceania (never, once, 2 – 3 times, more than 3 times, do not know). The details on how these variables were chosen have been previously published (52).…”

“…Participants were asked to complete an online questionnaire (52) containing questions about socio-demographic characteristics including date of birth (used to operationalize age in years), sex (female, male), educational level (according to the national educational system) and country of residence (Germany, the Netherlands, or Romania). The questionnaire also included questions about potential risk factors for carriage of ESBL-EC in the past year such as job history, hospital and farm visits (no, yes), contact with animals (no, yes), contact with patients or human tissues at work (never, rarely, sometimes, often, always), use of antibiotics and antacids (no, yes, do not know), self-reported health status (poor, fair, good, very good, excellent), self-reported frequency of diarrhea (never, rarely, sometimes, often, always), surgeries (no, yes), and international travel to Europe, Asia, North Africa, Sub-Saharan Africa, North America, Central America or Mexico, South America, and Australia or Oceania (never, once, 2 – 3 times, more than 3 times, do not know).…”

“…As part of the larger AWARE study (2,52), this study aimed to explore, describe, and characterize potential risk factors for carriage of ESBL-EC in a large sample of European individuals recruited from the general population in three countries with a different prevalence of AR, i.e. Germany, the Netherlands, and Romania.…”

Antimicrobial Resistance in New Zealand—A One Health Perspective

“…Sources include environmental water (surface water used for recreation, drinking water, water used for crop irrigation, and domestic, hospital and industrial wastewater), air (may also contain dust or water droplets), contact with animals and consumption of contaminated food. Certain occupations may have an increased risk of exposure to AMR determinants, including professions working at a slaughterhouse [ 18 ], a wastewater treatment plant (WWTP) [ 19 ] or with farm animals [ 20 ]. People residing in proximity to these workplaces may also have an increased risk of exposure [ 19 ].…”